| NPI | 1770925794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018036866) |
| 207Q00000X Family Medicine (Licence: TX q1323) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2025-03-05 |